Workers Compensation Claims Manager Jobs

Experience: Five (5) years of claims management experience or equivalent combination of education and experience required.

Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.

Coordinates vendor referrals for additional investigation and/or litigation management.

Refers cases as appropriate to supervisor and management.

Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.

Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.

We offer a hybrid remote work schedule

Why join the Contra Costa County Department of Risk Management?

An Effective Communicator. You will need to possess strong verbal, written, and listening skills

You will be expected to manage multiple assignments with competing deadlines

Knowledgeable in Workers Compensation Claims.

Adaptable. You will need to adjust easily to varied and changing priorities in a fast-paced environment

Calculates TTD, Wage Loss, VRMA and PD benefits

Issues compensation payments on diary schedule

Doctor status calls and Employee/Employer contact calls

Employer contact calls to confirm light duty/modifies work

Works closely with Claims Specialist to complete clerical assignments

Prepares litigation documents such as C&R, Stipulations, Answers, etc

Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.

Excellent oral and written communication, including presentation skills

Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.

Administers subrogation of claims and negotiates settlements.

Communicates claim action with claimant and client.

Ensures claim files are properly documented and claims coding is correct.

Organizational skills – attention to detail, time management, focus on priorities, thoroughness, follow up

Click Here to review our U.S. Eligibility Requirements

Learning to investigate claims with overall instruction, exposure and preparation

Analyzing & evaluating claims to make appropriate decisions & recommendations

Effectively communicating with clients and contacts

Continuous learning – understands before making judgements and acting, asks appropriate questions, learns from others and passes state specific licensing exams

Education & Licensing: 2+ years of claims management experience or equivalent combination of education and experience required.

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Professional certification as applicable to line of business preferred.

Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.

Bachelor's Degree/or equivalent in Risk Management, Business, Finance, or related field.

Verbal and written communication skills necessary to communicate with all levels of management and third-party providers

Apply aggressive litigation cost management strategy on individual WC claim files

Adhere to quality management and compliance protocols

Ensure WC vendors are complying with service instructions and guidelines and escalate specific issues to Manager

Confirm initial and ongoing TPA reporting of WC claims requiring excess notification, and escalate claims meeting defined criteria to Manager

Litigation management - Direct, manage, and control the litigation process.

Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.

Initiate the referral to the SIU of cases with suspected fraud.

Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.

Review and approve all vocational rehabilitation plans.

Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.

Advising employers on the proper management and impact of Workers’ Compensation claims

Healthcare benefits begin on your first day of employment

Hybrid work schedule: Three days in the office, two days from home

The prompt provision of benefits and assistance in early return to work

Computer Literacy with strong Microsoft Office capabilities

Excellent communication and organizational skills

Litigation Management - Direct, manage, and control the litigation process.

Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.

Initiate the referral to the SIU of cases with suspected fraud.

Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.

Review and approve all vocational rehabilitation plans.

Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.

Ability to attain all applicable state licenses within 30 days of hire and maintain appropriate continued education requirements

Notifies the Claim Manager/Supervisor of claims which require assignment to higher level Claims team members

Three years of claims support experience or related experience

Basic knowledge of insurance and claims processing

Strong knowledge of insurance and claims terminology

Good knowledge of computers, software, and applications

Excellent interpersonal and time management skills as well as a high degree of sound judgment, discretion, and initiative.

Partner with business units and TPA to utilize all tools available for ‘Return To Work’ programs, nurse case management, etc.

Communicate with the Director, Claims Management to develop case strategy in effort to ensure the best possible results

Assist with general liability, auto liability, subrogation, property claims and other special claim management projects as necessary (5%)

Develop and manage fleet management safety and claims programs for company car drivers (5%)

Special projects assigned by Director, Claims Management and VP, Risk Management (10%)

Apply your examiner, knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Professional certification as applicable to line of business preferred.

Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.

Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.

Education & Licensing: 8+ years of claims management experience or equivalent combination of education and experience required.

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

Compiles reviews and analyzes management reports and takes appropriate action.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Licensing / Jurisdiction Knowledge: Active adjuster license preferred and experience handling CA Workers Compensation Claims.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

You have 8+ years experience in compensation, designing and implementing compensation programs in high growth, quickly scaling global organizations

You have experience enhancing and implementing compensation systems and reporting tools

You have a Bachelor's degree in Business Administration / Finance, or other related field

This role offers a hybrid work schedule in our Culver City, CA office

You develop and implement fair compensation strategies for the attraction and retention of top talent

You excel at collecting, organizing, analyzing and disseminating significant amounts of information

Excellent verbal and written communication skills, time management and organizational skills.

Manages and approves payment of benefits within designated authority level.

Refers cases as appropriate to supervisor and management.

Minimum 1 year of insurance or claims related experience; or equivalent combination of education and experience required.

Assesses claims fairly and equitably, acting in the best interest of all parties and providing benefits as prescribed by law.

High school diploma or general education degree (GED) required.

Litigation management - Direct, manage, and control the litigation process.

Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.

Initiate the referral to the SIU of cases with suspected fraud.

Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.

Review and approve all vocational rehabilitation plans.

Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.

Negotiate and direct settlements under management's review

Effectively manage a caseload of loss time claims from numerous jurisdictions, including NY, PA, MA, NJ, MD, and TN.

A minimum of three years' experience required

Experience handling claims in NY, PA, MA, NJ, MD, or TN

Experience in handling lost time or litigated claims

Demonstration of strong organizational, problem solving, negotiation, and conflict resolution skills

Partners with HR and management to ensure timely communication to associates to minimize business disruptions

Primary point of contact for team members and managers regarding on-the-job injuries

Ensures that the workers’ compensation program is managed in accordance with applicable OSHA and workers’ compensation laws and regulations

Collaborates with finance and leadership for setting and approval of reserves

Manages the alternate duty program, working with managers and team members to ensure program compliance

Maintains knowledge of all applicable workers’ compensation, leave and accommodation laws including the FMLA, ADA, and state and local laws

Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.

Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

Professional certification as applicable to line of business preferred.

Opportunity to work in a remote or agile environment.

Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.